The Last Word

It is the news that no doctor wants to deliver and no patient
wants to hear, but preparing for the end-of-life is just as important as
preparing for the start of a life, according to internationally
recognised cancer care and health behaviour expert, Laureate Professor
Robert Sanson-Fisher AO.

Drawing on his more than 35 years' experience, the Director of the University of Newcastle's internationally recognised Centre for Health Behaviour and co-leader of HMRI's Public Health Program, Professor Sanson-Fisher is working on a number of ground-breaking research projects to change the mindset of dealing with illness and dying.

In a time fraught with high emotions and where crucial decisions need to be made, Professor Sanson-Fisher's research is setting the global benchmark for clinical practice guidelines and training for doctors to help reduce the emotional impact of terminal illnesses on patients and their families.

This includes spearheading a research project that analyses international approaches and cultural differences to end-of-life care, a study identifying communication and perception gaps between doctors, patients and families, as well as developing an internet-based system that keeps patients, families and caregivers on the same page.

"The nature of terminal illnesses, like cancer or cardiovascular disease, is that many people do not want to have the discussion about death, because there is fear that voicing this discussion is like jinxing or giving up, and will only increase stress on the patient," Professor Sanson-Fisher said.

"In actual fact, research shows that planning for death helps ease depression and anxiety. People who receive end-of-life care consistent with preferences are said to experience higher quality of life and lower physical and psychological distress," he said.

"Our research delves into the many areas of decision making that emerge towards the end-of-life, from treatment choices to legal parameters on who makes the decisions to quality of life preferences such as where and how you would like to be housed and who you would like to look after you.

"However, patient preferences often aren't clearly communicated to doctors and families, who become surrogate decision-makers. Providers then have to rely on the perceptions and personal views of family members rather than the patients themselves, at a time when the family members are incredibly stressed.

"There is increasing evidence to show that terminal cancer patients are receiving more treatments at the end-of-life than they might want if their views were sought. Planning helps reduce fear and stress, and helps everyone develop a shared understanding and sense of responsibility and values."

It is Professor Sanson-Fisher's aim to reshape thinking surrounding dying, so that preparations are as thorough for end-of-life as the other end of the spectrum – childbirth.

"With ageing population expected to increase, it is paramount that we begin to view preparation for end-of-life as a process as important as preparing for the birth of a baby. Improving end-of-life preparation has implications across many different sectors and industries, from government to legal to psychological, medical and aged care."

Professor Sanson-Fisher's Consensus Guidelines for Medical Practitioners on breaking bad news originally set the international benchmark for helping patients, families and doctors through the delicate and often heartbreaking discussion of how they would like their final days to play out.

An inaugural Director of the National Cancer Control Institute and New South Wales Cancer Education Research Program, Professor Sanson-Fisher has published more than 400 peer reviewed research papers on improving public health outcomes in the areas of behavioural science, cancer control and Indigenous health. This service was recognised when he was awarded the Officer of the Order of Australia for his work.

The Centre for Health Behaviour and the multidisciplinary research team for the Who Decides and at What Cost study brings a unique blend of clinical, legal, behavioural, bioethics, health economics, information technology and biostatistics expertise.

The study builds on the Centre's extensive experience and successes, and uses new research methodologies such as video, films and live scenarios to explore reactions and educate practitioners.

The Who Decides and at What Cost Study will be the first in the world to provide clinically relevant data on the degree to which providers and surrogate decision makers accurately reflect cancer patients' end-of-life decisions over time.

The study will also try to address evidence-based practice gap, which shows what clinicians should be doing and identifying where they are not meeting best practice and why they are not.

Professor Sanson-Fisher is also working on a study that analyses and compares approaches to end-of-life care in Australia, Japan, Vietnam and Korea.

"One of the interesting early indications from the initial international findings is that there appears to be universal consistencies surrounding discussions on dying," Professor Sanson-Fisher said.

"You would expect there to be variations between Japan, which is perceived as being a hierarchical society, compared to Vietnam which is considered a socialist society, versus Australia, a traditional family-dominated medical environment, where questioning medical practice is considered more common. However, there isn't much difference".

"Surprisingly however, advanced directives are much more common in Japan than they are here in Australia. So we are looking at research into why that might be and whether or not patients in Australia would like to have advanced directives.

Studies by Sanson-Fisher have indicated that patients with advanced, incurable cancer have high levels of unmet needs, especially in relation to the areas of psychological and medical communication and information.

Professor Sanson-Fisher believes that these unmet needs are largely driven by a gap between clinicians' expectations and a patient's expectations.

"An oncologist might tell a patient that a certain treatment might 'work'. The patient will interpret that as meaning the treatment will extend their life by years, but the oncologist actually means extending their life by three months," says Professor Sanson-Fisher.

Perception plays a key role, according to Professor Sanson-Fisher, who believes it is not so much about what is in the plan – but in the interpretation of what the patient would want.

"Doctors often talk about 'good' cancers, but most people think there are no good cancers to have. Oncologists deal with horrible situations every day and for patients this might be their first encounter with cancer.

"Their perceptions are completely different because they live in different worlds, but it's essential that we bridge this communication and perception gap for all parties' sake.

The timing of when to have the discussions is also being investigated, with Sanson-Fisher and his team developing frameworks that will assist caregivers to recognise the point at which psychosocial and emotional responses to patients' needs require specialist intervention.

"We're also researching when and how patient's advanced directives and patient preferences change over time. I have certainly seen patients say I don't want treatment when they are not a patient and then when they are a patient they say 'give me everything you've got'."

Sanson-Fisher and his team are currently trialling an internet-based research system to bridge this gap for leukaemia patients.

"Leukaemia and its treatment is a complex area. Blood cancers are much harder to understand and the decisions about what treatment plan to follow are therefore much harder.

"The internet-based information system outlines what treatment they are using, what the decisions and consequences are and what they can do to manage it.

"The site gives leukaemia patients, their families, their support team and their health team access to a central site any time they like to help everyone feel as though they are on the same page."

With 7.6 million people dying from cancer worldwide every year alone, Professor Sanson-Fisher is leading the way in helping the last goodbye become an easier one.

It is the news that no doctor wants to deliver and no patient wants to hear, but preparing for the end-of-life is just as important as preparing for the start of a life, according to internationally recognised cancer care and…

Career Summary

Biography

Research Expertise

Professor Rob Sanson-Fisher is
internationally recognised as a leader in health behavioural research.
His work is known for successfully combining behavioural and public
health approaches to health promotion, health service evaluation and
cancer control. He has published more than 263 peer review research
papers and 16 chapters in books. Rob has obtained numerous research
grants, including program grants from the NHMRC and other competitive
funding agencies. His current research interests are in changing health
care providers clinical behaviour so that it more closely approximates
best evidence practice, the development, implementation and evaluation
of attempting to improving the health outcomes for vulnerable population
groups. Professor Sanson-Fisher played a significant role in
establishing the Behavioural Science Group in Relation to Medicine at
the University of Newcastle. He also was the initiator of the Hunter
Centre for Health Advancement and Director of the New South Wales Cancer
Education Research Program.health service models, assessment of unmet
needs of cancer patients and The research training and publications,
which resulted from this group, have received national and international
recognition. These research achievements were recognised with the group
being designated a WHO Centre of Excellence with Professor Sanson-
Fisher as the director. He was the inaugural director of the National
Cancer control Institute. More recently Rob finished a four-year term as
Dean of the Faculty of Medicine at the University of Newcastle. In 2000
he was awarded the Hunter Medical Research Institute Award for Research
Excellence.

Qualifications

PhD, University of Western Australia

Master of Psychology (Clinical), University of Western Australia

Bachelor of Psychology, University of Western Australia

Keywords

Psycho-social/ Behavioural

Public Health

Fields of Research

Code

Description

Percentage

111299

Oncology and Carcinogenesis not elsewhere classified

25

160508

Health Policy

15

111799

Public Health and Health Services not elsewhere classified

60

Professional Experience

UON Appointment

Title

Organisation / Department

Laureate Professor

University of NewcastleSchool of Medicine and Public HealthAustralia

Academic appointment

Dates

Title

Organisation / Department

1/01/2003 - 1/01/2007

Director

Mater Hospital BoardAustralia

1/01/1999 - 1/01/2000

Chairperson

NSW Cancer CouncilAustralia

1/01/1999 - 1/01/2001

Chairperson

NHMRC (National Health & Medical Research Council)

1/01/1998 - 1/01/2001

Member of Executive Committee

Newcastle Institute of Public HealthAustralia

1/01/1998 - 1/01/2001

Dean

University of NewcastleFaculty of Medicine and Health SciencesAustralia

1/01/1996 - 1/01/1997

Inaugural Director

Australian Commonwealth Government National Cancer Control InitiativeAustralia

1/01/1992 - 1/01/1997

Inaugural Director

University of NewcastleHunter Centre For Health AdvancementAustralia

1/01/1992 - 1/01/1995

Director

University of NewcastleWHO Centre for Health Behaviour ResearchAustralia

Issues addressed The National Bowel Cancer Screening Program (NBCSP) was introduced in Australia in 2006, offering free immunochemical Faecal Occult Blood Test (FOBT) to persons aged 50, 55 or 65. The study aimed to examine the prevalence of self-reported screening for colorectal cancer (CRC) using the FOBT and factors associated with not having an FOBT. Methods A cross-sectional study of Australian general practice patients aged 50 and over with no personal history of CRC completed a health risk survey while waiting for scheduled appointments between November 2010 and November 2011. Results A total of 5671 patients from 12 practices were approached to participate. Of the 4707 eligible patients (adults attending for care who understood English and were capable of providing informed consent), 4062 (86%) consented to participate, with 2269 eligible to complete the FOBT items. Approximately half (52%) of participants reported ever having an FOBT. More than one-third (39.7%) of the sample reported having an FOBT in the prior three years. Those who recalled receiving a mailed kit as part of the NBCSP were five times more likely to report being screened. Those less likely to report screening were aged 50-59 years, were female and had been diagnosed with a form of cancer other than CRC. Conclusions There is justification for the extension of the NBCSP to ensure a majority of the age-appropriate population is screened for CRC. So what? Further work is needed to identify whether high rates of screening are achievable using the mailed-kit approach, and how to increase participation by females, those aged 50-69 years and those diagnosed with other cancers.

Background: In order to provide smoking cessation support to their patients in line with clinical practice guidelines, general practitioners must first ascertain whether their pat... [more]

Background: In order to provide smoking cessation support to their patients in line with clinical practice guidelines, general practitioners must first ascertain whether their patients' use tobacco. This study examined (i) the sensitivity, specificity, positive predictive value and negative predictive value of general practitioner detection of smoking, and (ii) the general practitioner and patient characteristics associated with detection of tobacco use. Methods: Eligible patients completed a touchscreen computer survey while waiting for an appointment with their general practitioner. Patients self-reported demographic characteristics, medical history, and current smoking status. Following the patient's consultation, their general practitioner was asked to indicate whether the patient was a current smoker (yes/no/unsure/not applicable). Smoking prevalence, sensitivity, specificity, positive predictive value and negative predictive values (with 95% confidence intervals) were calculated using patient self-report of smoking status as the gold standard. Generalised estimating equations were used to examine the general practitioner and patient characteristics associated with detection of tobacco use. Results: Fifty-one general practitioners and 1,573 patients in twelve general practices participated. Patient self-report of smoking was 11.3% compared to general practitioner estimated prevalence of 9.5%. Sensitivity of general practitioner assessment was 66% [95% CI 59-73] while specificity was 98% [95% CI 97-98]. Positive predictive value was 78% [95% CI 71-85] and negative predictive value was 96% [95% CI 95-97]. No general practitioner factors were associated with detection of smoking. Patients with a higher level of education or who responded 'Other ' were less likely to be detected as smokers than patients who had completed a high school or below level of education. Conclusion: Despite the important role general practitioners play in providing smoking cessation advice and support, a substantial proportion of general practitioners do not know their patient's smoking status. This represents a significant missed opportunity in the provision of preventive healthcare. Electronic waiting room assessments may assist general practitioners in improving the identification of smokers.

Background: Translational biomedical research relies on the availability of human tissue to explore disease aetiology and prognostic factors, with the objective of developing bett... [more]

Background: Translational biomedical research relies on the availability of human tissue to explore disease aetiology and prognostic factors, with the objective of developing better targeted treatments. The establishment of biobanks poses ongoing ethical considerations in relation to donors. This is a quantitative study exploring medical oncology patients' preferences for contributing to tissue biobanks. Methods: The objectives of this study were to explore oncology patients' preferences about tissue banking, including: 1) willingness to donate; 2) factors influencing donation decisions; 3) preferences about the use of donated tissue including permission systems, data linkage, and communication about research findings to donors. A cross-sectional survey was conducted in two tertiary oncology outpatient clinics. Eligible patients were approached by volunteers to complete a touchscreen survey in waiting rooms or while receiving intravenous therapy. Consenting participants completed demographic questions and received up to 12 previously validated items exploring preferences for donating tissue. Results: 224 oncology outpatients participated over a ten month period (69.1 % consent rate; 64.4 % completion rate). Most participants were female (54 %), were a mean age of 62 years, and diagnosed with breast (26 %) and bowel (20 %) cancer. Most participants indicated willingness to donate tissue (84 %) and for their sample to be stored for future use (96 %). Participants preferred a blanket consent approach (71 %), samples to be linked to medical records (62 %) and for general results of the research (79 %) to be provided to them. Factors influencing willingness to donate tissue included personal (85 %) or familial health benefits (88 %) and a sense of duty to future patients (82 %). Conclusions: The overwhelming majority of oncology patients are willing to participate in a tissue bank, providing some support to explore 'opt-out' models of consent. To enhance patient acceptability, tissue banking programs should: (i) consider allowing blanket informed consent as well as opt-in models of consent; (ii) develop protocols allowing feedback of information about samples in line with patient preferences; (iii) provide clear information to potential donors about the benefits arising from donation.

Objective Patient-reported outcome measures (PROMs) that assess the quality of patient-centred cancer care have failed to measure all six patient-centredness dimensions endorsed by the Institute of Medicine (IOM). This study is the first to use the Quality of Patient-Centered Cancer Care (QPCCC) measure that covers all six IOM patient-centredness dimensions to examine haematological cancer survivors' perceptions of care and characteristics associated with perceived quality of care. Methods Haematological cancer survivors diagnosed in the last 6 years and aged 18-80 years were recruited from two Australian state population-based cancer registries. Survivors were mailed the 48-item QPCCC measure. Results Overall, 545 haematological cancer survivors completed the measure. Areas of care most commonly identified as delivered were hospital staff showing respect to survivors (93%) and making sure the correct treatment was received (93%). Aspects of care most frequently nominated as not delivered were hospital staff helping family and friends (34%) or the survivor (32%) to find other people with similar experiences to talk to. Characteristics associated with survivors perceiving higher quality care was delivered included being employed, having private health insurance, being younger, a Non-Hodgkin lymphoma diagnosis and more recent diagnosis. Being depressed or stressed was associated with perceived lower quality of care. Conclusions Provision of peer support programs that allow haematological cancer survivors and families and friends to talk to others in similar situations could be improved. Using PROMs to identify areas where cancer survivors perceive improvements are needed is essential to quality improvement efforts.

Background: Emergency department staff play a crucial role in the triage of stroke patients and therefore the capacity to deliver time-dependent treatments such as tissue Plasmino... [more]

Background: Emergency department staff play a crucial role in the triage of stroke patients and therefore the capacity to deliver time-dependent treatments such as tissue Plasminogen Activator. This study aimed to identify among emergency physicians, (1) rates of agreement with evidence supporting tissue Plasminogen Activator use in acute stroke care; and (2) individual and hospital factors associated with high agreement with evidence supporting tissue Plasminogen Activator use. Methods: Australian fellows and trainees of the Australasian College for Emergency Medicine were invited to complete an online cross-sectional survey assessing perceptions of tissue Plasminogen Activator use in acute stroke. Demographic and hospital characteristics were also collected. Results: 429 Australasian College for Emergency Medicine members responded (13% response rate). Almost half (47.2%) did not agree with any statements regarding the benefits of tissue Plasminogen Activator use for acute stroke. Perceived routine administration of tissue Plasminogen Activator by the head of respondents' emergency department was significantly associated with high agreement with the evidence supporting tissue Plasminogen Activator use in acute stroke. Conclusions: Agreement with evidence supporting tissue Plasminogen Activator use in acute stroke is not high among responding Australian emergency physicians. In order for tissue Plasminogen Activator treatment to become widely accepted and adopted in emergency settings, beliefs and attitudes towards treatment need to be in accordance with clinical practice guidelines.

To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and... [more]

To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and women in antenatal services providing care for Indigenous women in the Northern Territory and New South Wales, Australia. Respondents were asked to indicate the extent to which each of a list of possible strategies would be helpful in supporting pregnant Indigenous women to quit smoking. Current smokers (nÂ¿=Â¿121) were less positive about the potential effectiveness of most of the 12 strategies than the providers (nÂ¿=Â¿127). For example, family support was considered helpful by 64Â¿% of smokers and 91Â¿% of providers; between 56 and 62Â¿% of smokers considered advice and support from midwives, doctors or Aboriginal Health Workers likely to be helpful, compared to 85Â¿90Â¿% of providers. Rewards for quitting were considered helpful by 63Â¿% of smokers and 56Â¿% of providers, with smokers rating them more highly and providers rating them lower, than most other strategies. Quitline was least popular for both. This study is the first to explore views of pregnant Australian Indigenous women and their antenatal care providers on strategies to support smoking cessation. It has identified strategies which are acceptable to both providers and Indigenous women, and therefore have potential for implementation in routine care. Further research to explore their feasibility in real world settings, uptake by pregnant women and actual impact on smoking outcomes is urgently needed given the high prevalence of smoking among pregnant Indigenous women.

To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and... [more]

To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and women in antenatal services providing care for Indigenous women in the Northern Territory and New South Wales, Australia. Respondents were asked to indicate the extent to which each of a list of possible strategies would be helpful in supporting pregnant Indigenous women to quit smoking. Current smokers (nÂ¿=Â¿121) were less positive about the potential effectiveness of most of the 12 strategies than the providers (nÂ¿=Â¿127). For example, family support was considered helpful by 64Â¿% of smokers and 91Â¿% of providers; between 56 and 62Â¿% of smokers considered advice and support from midwives, doctors or Aboriginal Health Workers likely to be helpful, compared to 85Â¿90Â¿% of providers. Rewards for quitting were considered helpful by 63Â¿% of smokers and 56Â¿% of providers, with smokers rating them more highly and providers rating them lower, than most other strategies. Quitline was least popular for both. This study is the first to explore views of pregnant Australian Indigenous women and their antenatal care providers on strategies to support smoking cessation. It has identified strategies which are acceptable to both providers and Indigenous women, and therefore have potential for implementation in routine care. Further research to explore their feasibility in real world settings, uptake by pregnant women and actual impact on smoking outcomes is urgently needed given the high prevalence of smoking among pregnant Indigenous women.

Objective: Patient-reported outcome measures (PROMs) that assess the quality of patient-centred cancer care have failed to measure all six patient-centredness dimensions endorsed by the Institute of Medicine (IOM). This study is the first to use the Quality of Patient-Centered Cancer Care (QPCCC) measure that covers all six IOM patient-centredness dimensions to examine haematological cancer survivors' perceptions of care and characteristics associated with perceived quality of care. Methods: Haematological cancer survivors diagnosed in the last 6 years and aged 18-80 years were recruited from two Australian state population-based cancer registries. Survivors were mailed the 48-item QPCCC measure. Results: Overall, 545 haematological cancer survivors completed the measure. Areas of care most commonly identified as delivered were hospital staff showing respect to survivors (93%) and making sure the correct treatment was received (93%). Aspects of care most frequently nominated as not delivered were hospital staff helping family and friends (34%) or the survivor (32%) to find other people with similar experiences to talk to. Characteristics associated with survivors perceiving higher quality care was delivered included being employed, having private health insurance, being younger, a Non-Hodgkin lymphoma diagnosis and more recent diagnosis. Being depressed or stressed was associated with perceived lower quality of care. Conclusions: Provision of peer support programs that allow haematological cancer survivors and families and friends to talk to others in similar situations could be improved. Using PROMs to identify areas where cancer survivors perceive improvements are needed is essential to quality improvement efforts.

Background: To facilitate translation of evidence into clinical practice, it is critical that clear, specific, and detailed information about interventions is provided in publicat... [more]

Background: To facilitate translation of evidence into clinical practice, it is critical that clear, specific, and detailed information about interventions is provided in publications to promote replication, appropriate aggregation in meta-analysis, and implementation. This study examined whether twenty elements of interventions deemed essential for such translational application were reported in sufficient detail in smoking cessation trials with pregnant women. Methods: Searches of electronic databases using MeSH terms and keywords identified peer-reviewed English language studies published between 2001 and 2012. Eligible studies reported a smoking cessation intervention targeted at pregnant women and met Cochrane's Effective Practice and Organization of Care group study design criteria. Each intervention arm of eligible studies was assessed against the developed twenty criteria. Results: Thirty relevant studies reported the findings of 45 intervention arms. The mode of delivery of the intervention was reported in 100% of intervention arms. Other well-reported criteria included reporting of the provider who delivered the intervention (96%), sample characteristics (80%), and the intervention setting (80%). Criteria not reported adequately included care provided to women who relapse (96% not reported), details about training given to providers (77% not reported), and the method of quit advice advised (76% not reported). No studies reported 100% of relevant criteria. Conclusions: Current standards of reporting of intervention content and implementation are suboptimal. The use of smoking cessation specific checklists for reporting of trials, standard reporting using behaviour change taxonomies, and the publication of protocols as supplements should be considered as ways of improving the specificity of reporting.

Prevention in the oncology setting has traditionally focused on the progression of cancer, recurrence and development of new cancers. Increasingly, the focus has moved to a more h... [more]

Prevention in the oncology setting has traditionally focused on the progression of cancer, recurrence and development of new cancers. Increasingly, the focus has moved to a more holistic view of prevention that pursues prevention of suffering and maintaining quality of life. The cancer treatment team has the opportunity to play an active role in the promotion of healthy lifestyles for patients, and the relatives for whom the patient's cancer conveys risk. Assisting patients to adhere to 'non-cancer' care is important for their mortality and morbidity. Given patient's reluctance to disclose physical and emotional side-effects they may be experiencing, there is a need for health providers to regularly initiate discussions with their patients about their needs. Similarly, an oncology service that actively seeks to understand patient preferences will be better equipped to provide individualised care. A systems-minded approach to prevention may ensure that cancer care is organised to anticipate and to prevent of poor quality care. As the cancer treatment team will continue to play a more complex role in prevention, they must be supported by organisational factors that facilitate evidence-based practice.

Lynagh MC, Sanson-Fisher RW, Bonevski B, 'What's Good for the Goose is Good for the Gander. Guiding Principles for the Use of Financial Incentives in Health Behaviour Change', INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, 20 114-120 (2013) [C1]

Yoong SL, Carey M, Sanson-Fisher R, D'Este C, 'Prevalence and correlates of overweight and obesity in adult Australian general practice patients', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, 37 586-586 (2013) [C3]

Background. The extent of use of antibiotics to treat upper respiratory infections in general practice is an area for concern due to the increasing problem of bacterial resistance... [more]

Background. The extent of use of antibiotics to treat upper respiratory infections in general practice is an area for concern due to the increasing problem of bacterial resistance. Effective educational strategies to promote rational prescribing are needed. Objectives. We aimed to examine the effectiveness of prescriber feedback and management guidelines in reducing antibiotics prescribing by GP trainees for undifferentiated upper respiratory tract infection, and in improving the choice of antibiotic for tonsillitis/streptococcal pharyngitis. The research tested a stepwise approach to targeting educational input to high prescribers. Method. General Practice trainees in New South Wales (n = 157) were randomly allocated to a treatment group (n = 78) which received an education intervention on antibiotic use, or to a control group (n = 79) which received an intervention on an unrelated topic. Trainees completed three practice activity surveys, each of 110 consecutive patient encounters, with 6-month intervals between surveys. Prescriber feedback and management guidelines on use of antibiotics for URTI and choice of antibiotic for tonsillitis/streptococcal pharyngitis were delivered in a written form between surveys 1 and 2. An educational outreach visit to high prescribers occurred between surveys 2 and 3. Outcome measures were the rate of antibiotic prescribing for all indications, for URTI and prescribing of select antibiotics for tonsillitis/streptococcal pharyngitis. Results. Antibiotic prescribing by the intervention group declined over three occasions from 25.0 to 23.3 to 19.7 per 100 URTI problems, while the control group increased from 22.0 to 25.0 to 31.7 per 100 URTI problems (P = 0.002). Prescribing in agreement with accepted guidelines for tonsillitis/streptococcal pharyngitis increased over time in the intervention group from 55.6 to 69.8 to 73.0 per 100 problems, but decreased in the control group from 59.6 to 57.5 to 58.5 (P = 0.05). Conclusion. Prescriber feedback and management guidelines were shown to influence antibiotic prescribing for URTI and choice of antibiotic for tonsilitis/streptococcal pharyngitis. This study provides a model for targeting educational input to those prescribers who most need to change their behaviour.

Binge consumption contributes substantially to the occurrence of alcohol-related harm. Despite its importance, binge drinking is not well defined in the literature. The present st... [more]

Binge consumption contributes substantially to the occurrence of alcohol-related harm. Despite its importance, binge drinking is not well defined in the literature. The present study examines the proportions of respondents identified as binge drinkers by three separate measures: a 1- week retrospective drinking diary (RD), the Alcohol Use Disorders Identification Test (AUDIT), and a quantity/frequency (QF) question. Overall, AUDIT detected the highest proportion of binge drinkers, followed by QF and RD. There was also good agreement between QF and RD, as well as QF and AUDIT. Ultimately, the measure of choice should be that which provides information most appropriate to the purposes of each study.

Doran CM, Girgis A, Sanson-Fisher RW, 'Smoking by adolescents: Three years later, there's even larger revenue but little for prevention', Australian and New Zealand Journal of Public Health, 22(3) 321-323 (1998) [C1]

Increasingly, courses in communication skills are being incorporated into medical training. In order for communication skills to be effectively maintained in post-training medical... [more]

Increasingly, courses in communication skills are being incorporated into medical training. In order for communication skills to be effectively maintained in post-training medical practice, they must be taught within an appropriate clinical context. The present paper describes and provides rationale for seven criteria by which to select clinical issues which are appropriate foci for communication skills courses. The criteria are: (1) the issue must be one which is encountered frequently in clinical practice; (2) the issue must be associated with a high burden of illness; (3) there must be evidence that practitioners need to improve skills for dealing with the issue; (4) there must be an intervention, of which communication skills are an integral component, that is demonstrably effective for dealing with the clinical issue; (5) the intervention must represent a cost-effective means of dealing with the issue; (6) the intervention must be acceptable to doctors and be able to be incorporated into routine medical practice; (7) the intervention must be acceptable to patients. Examples of clinical issues which fit these criteria are given in the paper and include smoking, hazardous alcohol consumption, non-adherence to treatment instructions, overdue cervical screening, inappropriate diet, recovery from medical interventions, and breaking bad news to patients.

Guidelines for preparing cancer patients for threatening medical procedures were developed and refined and their perceived relevance and importance rated by three concerned groups... [more]

Guidelines for preparing cancer patients for threatening medical procedures were developed and refined and their perceived relevance and importance rated by three concerned groups - 84 breast cancer patients, 64 doctors, and 140 nurses and nurse oncologists. All three groups indicated strong support for the guidelines. Patients and nurses rated more of the guidelines as essential aspects of good quality care than did doctors. Items in which a significant discrepancy existed included the importance of (a) consistent information, (b) involvement of others in preparation, and (c) assistance to the patient in coping with treatment for breast cancer. Doctors, compared with patients and nurses, underrated the importance of some aspects of preparation. These issues should be given more prominence in undergraduate and specialist medical training, as well as in continuing medical education.

Aim. Despite a large body of literature, a substantial burden of illness related to the abuse of alcohol, as well as significant economic and social costs, persist. As such, a cri... [more]

Aim. Despite a large body of literature, a substantial burden of illness related to the abuse of alcohol, as well as significant economic and social costs, persist. As such, a critical examination of the type of research being published in relation to alcohol misuse seems appropriate, particularly since some experts in the field have expressed the view that the current distribution of research types may not be optimal. Findings. The types of research conducted in two separate years, 1983 and 1993, were examined critically. Generally, the types of research conducted in both years was found to be similar: the majority of published alcohol research is behavioural, the majority of published behavioural alcohol research is descriptive and the majority of published behavioural intervention alcohol research represents tertiary prevention studies. Although the reasons for this distribution of research types are undoubtedly numerous and complex, some possible explanations are discussed. Conclusions. Overall, it is concluded that the current approach to alcohol research may have engendered a distribution of research types which is somewhat less than ideal and that, as such, a new approach may be indicated. Some strategies that may assist in redressing the perceived imbalance are considered.

This study sought the views of midwives and obstetricians about what they considered to be important aspects of routine antenatal care. Midwives and obstetricians were randomly se... [more]

This study sought the views of midwives and obstetricians about what they considered to be important aspects of routine antenatal care. Midwives and obstetricians were randomly selected from the NSW membership lists of the Australian College of Midwives and The Royal Australian College of Obstetricians and Gynaecologists, respectively. Seventy-eight percent of midwives (n = 196) and 52% of obstetricians (n = 114) completed a questionnaire which itemised components of routine care derived from the National Health and Medical Research Council's Guidelines for Antenatal Care. Participants were asked to rate each of the 77 components on a 4-point scale as either: very important; desirable but not essential; not necessary; or, don't know. Twenty-four (31%) of the components were rated as very important by at least 90% of midwives and 19 (22%) were rated as very important by at least 90% of obstetricians. 'Recording details of previous pregnancy complications' was the component most commonly rated as being very important by both groups. On 37 (48%) of the components there was a significant difference between midwives and obstetricians in terms of whether or not they rated the component as very important (p < 0.01). There were considerable differences between midwives' and obstetricians' views about the important components of routine antenatal care and a substantial proportion of both groups did not consider many of the components listed in the guidelines to be essential in routine care. The findings suggest that a revision of the current antenatal care guidelines is necessary.

The study assessed the effectiveness of a programme aimed at increasing medical students' skills in counselling patients presenting for HIV testing/AIDS information. Senior medical students were randomly assigned to receive a short course in pre- and post-test counselling, or to a control group which received the usual curriculum. The students' performance in counselling simulated patients was videotaped at baseline and after 3 months. A subsample was also assessed at 12 months. Students receiving the programme showed significantly greater improvement in pre- and post-test counselling skills over 3 months than did the controls. For the subsample continuing to 12 months, a significant effect over time was found; however, there was no significant difference between the groups. This may have been influenced by the small sample sizes used for the 12-month assessment. General interactional skills improved for the overall sample over 3 and 12 months, but again there were no significant differences between groups. Those exposed to the programme did not show significantly greater changes in either knowledge or attitude scores over either time frame, compared with controls. When taught in addition to the usual undergraduate curriculum at Newcastle University, this short interactional skills course significantly enhanced students' ability to provide pre- or post-test counselling for HIV/AIDS.

Background. Cancer patients face a frightening array of potentially threatening medical interventions. While the need to prepare patients for such procedures is widely acknowledge... [more]

Background. Cancer patients face a frightening array of potentially threatening medical interventions. While the need to prepare patients for such procedures is widely acknowledged, there have been few attempts to clearly specify in detail what adequate preparation entails. Methods. This study sought to develop a set of guidelines on how to prepare cancer patients for potentially threatening medical procedures. These guidelines were extensively reviewed and modified by a consensus panel of experts. The guidelines were then rated by 101 cancer patients. Results and Conclusions. These ratings led to further modification of the guidelines, the final version of which was developed into a training module for junior medical officers in New South Wales.

Byles JE, SansonFisher RW, 'Mass mailing campaigns to promote screening for cervical cancer: Do they work, and do they continue to work?', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, 20 254-260 (1996)

Girgis A, Sanson-Fisher R, 'Community based health education: general practitioners' perceptions of their role and willingness to participate.', Australian and New Zealand journal of public health, 20 381-385 (1996)

BACKGROUND--Debate exists about the definition of what constitutes an adequate Pap smear and about the recommended rescreening interval for Pap smears lacking an endocervical comp... [more]

BACKGROUND--Debate exists about the definition of what constitutes an adequate Pap smear and about the recommended rescreening interval for Pap smears lacking an endocervical component. This study aimed at determining whether women are currently informed about the endocervical status of their Pap smears and what rescreening recommendations are made to women whose smears lack endocervical cells. METHOD--Consecutive Pap smears lacking an endocervical component were identified from pathology records. After obtaining consent from the referring doctor, 165 women were interviewed by telephone. RESULTS--Only 110 (67%) of 165 women received active notification of their Pap test result and only six (4%) were aware that their smear lacked endocervical cells. Thirteen (8%) had been advised to have a repeat smear within three months. Nearly half the women reported that they would like more information about their result. CONCLUSIONS--It seems that current Pap smear notification patterns for women in New South Wales could be improved. One third are not actively informed at all about their results, and few are given detailed information about their Pap test results. Methods of enhancing the level of information women are given about their medical and screening tests need to be improved.

OBJECTIVE: To assess the comparative efficacy, by randomised controlled trial, of three interventions designed to encourage "at risk" women to have a Pap smear: an educational pam... [more]

OBJECTIVE: To assess the comparative efficacy, by randomised controlled trial, of three interventions designed to encourage "at risk" women to have a Pap smear: an educational pamphlet; letters inviting attendance at a women's health clinic; and letters from physicians. METHODS: Subjects at risk for cervical cancer who had not been adequately screened were identified by a random community survey and randomly allocated to one of the intervention groups or a control group. Six months after intervention implementation, a follow up survey assessed subsequent screening attendance. Self report was validated by comparison with a national screening data base. RESULTS: A significantly greater proportion of women (36.9%) within the group receiving a physician letter reported screening at follow up than in any other group (P = 0.012). The variables most strongly predicting screening attendance were: age, perceived frequency of screening required, use of oral contraceptives, and allocation to receive the physician letter intervention. CONCLUSIONS: The relative efficacy of the GP letter in prompting screening attendance shows that this strategy is worthy of further investigation. There remains a need to examine the barriers to screening for older women, and to develop tailored strategies for this population.

A review of studies on the relationship between alcohol and work injuries revealed that the evidence is contradictory and that many of the studies contain methodological flaws. Th... [more]

A review of studies on the relationship between alcohol and work injuries revealed that the evidence is contradictory and that many of the studies contain methodological flaws. The present study aimed to determine whether there are relationships between problem drinking and high alcohol consumption and outcomes such as work injuries and related absences. The sample consisted of 833 employees at an industrial worksite. Problem drinking was measured by the Mortimer-Filkins test, while alcohol consumption was measured by a 7-day retrospective diary. Work injury data were obtained from medical reports completed at the worksite medical center, while absences data were obtained from company records. Chi-square analyses revealed significant relationships between problem drinking and work injuries and injury-related absences, but not between high alcohol consumption and work injuries and related absences. Logistic regression analysis revealed that no variables were significant predictors of work injuries. However, when uninjured subjects were excluded, a second analysis revealed that Mortimer-Filkins test scores, recent stressful life events, age and job satisfaction were significant predictors of two or more injuries. Injured subjects were almost twice as likely to have two or more injuries if they had high numbers of recent stressful life events and low levels of job satisfaction. Logistic regression analysis revealed that age, Mortimer-Filkins test categories and job satisfaction significantly predicted injury-related absences. Problem drinkers were 2.7 times more likely to have injury-related absences than non-problem drinkers, and subjects with low levels of job satisfaction were 2.2 times more likely than others to have injury-related absences. The implications of the results for workplace alcohol policies and programs are discussed.

It is argued that psychologists have an important role in ensuring appropriate training of medical students in behavioural and cognitive strategies. This paper outlines the innova... [more]

It is argued that psychologists have an important role in ensuring appropriate training of medical students in behavioural and cognitive strategies. This paper outlines the innovative medical curriculum at the University of Newcastle and describes the contribution of cognitive psychology to the problem-solving method which underlies the curriculum. It also describes the medical school's approach to training students in interactional skills. One focus of the interactional skills training is to provide practical skills which incorporate behavioural and cognitive strategies to address common, preventable health problems, such as excessive alcohol consumption.

OBJECTIVE: Evaluation of three potential methods for increasing Pap smear use: television media, television media combined with letter based recruitment, and television media comb... [more]

OBJECTIVE: Evaluation of three potential methods for increasing Pap smear use: television media, television media combined with letter based recruitment, and television media combined with general practitioner based (GP based) recruitment. SETTING: A trial of each intervention was carried out in three postal regions in New South Wales, Australia-a rural locality (containing about 1000 women), a country town (about 3000 women), and a major rural centre (about 10,000 women). Three control regions were selected to be demographically similar to the corresponding intervention regions. METHODS: Outcome data on regional Pap smear rates were obtained from government health insurance claims for cervical screening, and from pathology service records. Expected Pap smear rates for the three months after the intervention were predicted from 45 pre-intervention months and were compared with observed rates for this period. RESULTS: Television media alone was associated with a significant increase in attendances for screening in one of the three regions where a trial was carried out: 13.3% in the rural centre. The media/letter based campaign was associated with a significant increase in attendances in two out of three regions: 52.7% in the rural locality, 43.2% in the rural centre. The media/GP based campaign was associated with significant increases in attendances in all three regions: 50.2% in the rural locality, 80.8% in the country town, 15.7% in the rural centre. All three interventions were associated with significant increases in the number of women attending for cervical screening above those observed in the control regions. Furthermore, these increases were not restricted to women at low risk. They were also found for older women (aged 50-69 years) and women who had not had a Pap smear within the past three years.

Redman S, Henrikus D, Clover K, Sanson-Fisher R, 'Responses of women and their doctors to the occurrence of a breast symptom: A community study', Health Promotion International, 8 177-187 (1993)

Public and professional education programmes have emphasized the need for prompt diagnosis and treatment of breast symptoms in improving mortality and morbidity related to breast ... [more]

Public and professional education programmes have emphasized the need for prompt diagnosis and treatment of breast symptoms in improving mortality and morbidity related to breast cancer. The present study of a randomly selected community sample explored the responses of women and their doctors to the occurrence of a breast symptom. One thousand and forty-one women were asked to participate in the study and 745 consented (72%). Sixteen per cent of the women had experienced breast symptoms which were potentially cancer-related, and 21% had experienced period -related breast lumps at some time in their lives. Responses of women and their doctors were examined for those women who had first experienced a potentially cancer-related symptom (n = 63) or period-related lump (n = 68) within the past five years. Of women with potentially cancer-related symptoms, 29% had never visited their doctor about the symptom and a further 21% delayed attending for more than two weeks after detecting the symptom. Similarly of those women with period-related breast lumps, 21% had never visited their doctors and 26% had delayed for two weeks or more after finding the lump. Only 54% of women who reported potentially cancer-related symptoms were referred to a specialist. Women may be more likely to attend or visit their doctor if health education messages are viewed as non-threatening. The results are discussed in terms of the need for professional and public education programmes.

Increasing skin cancer rates highlight the need to reduce the amount of solar exposure of young children. Children in early childcare are one potential target group for improved s... [more]

Increasing skin cancer rates highlight the need to reduce the amount of solar exposure of young children. Children in early childcare are one potential target group for improved sun protection policy and practice. Solar protection policies and practices in 51 randomly selected early childcare centres in the Hunter Region of New South Wales, Australia were examined. Only 18% of centres had written policies and 36% of centres unwritten policies, predominantly hat and sunscreen policies. The sun protection practices of 306 children across the 51 centres was also examined. The adoption of specific policies by the centre was not associated with increased protection of children within that centre. The need for effective implementation and maintenance strategies is highlighted.

While primary care has considerable potential as a site for detecting and intervening for alcohol-related problems, few doctors currently identify these problems. The judgments of... [more]

While primary care has considerable potential as a site for detecting and intervening for alcohol-related problems, few doctors currently identify these problems. The judgments of eight primary care physicians about alcohol- related problems in 371 of their patients were compared with the patients' responses to the Short Michigan Alcoholism Screening Test (SMAST) and the CAGE. The CAGE classified 11.4% of the patients as alcoholics and the SMAST identified 23.9% as probable alcoholics. However, the doctors identified only a small proportion (7.0%) of their patients as having any level of alcohol- related problem. The doctors did not identify 65.0% of CAGE-defined alcoholics and 82.3% of those patients classified by the SMAST as probable alcoholics. The discrepancy between primary care physician's judgments and the SMAST and CAGE may be attributable to the doctor's failure to identify patients with alcohol-related problems. An alternative explanation is that the SMAST and CAGE are inappropriate screening tools for use in Australian primary care. The findings are discussed in terms of the implications for training doctors and for the development of better measures of alcohol- related problems for use within a primary care context.

Gordon JJ, Saunders NA, Hennrikus D, Sanson-Fisher RW, 'Interns' performances with simulated patients at the beginning and the end of the intern year', Journal of General Internal Medicine, 7 57-62 (1992)

Most studies of work injuries use aggregate data about severe injuries resulting in time off work. These studies do not provide information about all injuries, particularly minor ... [more]

Most studies of work injuries use aggregate data about severe injuries resulting in time off work. These studies do not provide information about all injuries, particularly minor injuries. The present study investigated all injuries at a large metal manufacturing plant over a one-year period. Data collected for 1,740 injuries to 639 subjects included type of injury, part of the body injured, temporal variables, work variables, and individual worker variables. The most common types of injuries were soreness and pain, lacerations, superficial injuries and foreign bodies. The most common parts of the body injured were fingers, arms and eyes. Injuries were more likely to occur on Mondays. Injury occurrence peaked during the mid-morning and after lunch. Blue-collar workers had significantly higher rates of injuries and significantly more severe injuries than white-collar workers. Young workers were more likely to have injuries than older workers. Workers with less than three years' experience were significantly more likely to have injuries than other workers. The implications of these findings for prevention of work injuries are explored.

SCHOFIELD MJ, HENNRIKUS DJ, REDMAN S, SANSONFISHER RW, 'PREVALENCE AND CHARACTERISTICS OF WOMEN WHO HAVE HAD A HYSTERECTOMY IN A COMMUNITY SURVEY', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, 31 153-158 (1991)

To develop strategies to overcome barriers to preventive care in general practice. Method: Participants invited to attend a one-day workshop ranked barriers to preventive care in ... [more]

To develop strategies to overcome barriers to preventive care in general practice. Method: Participants invited to attend a one-day workshop ranked barriers to preventive care in a pre-workshop survey. During the workshop, small groups generated strategies to overcome the most influential barriers. After the workshop, participants nominated strategies for implementation in the ideal world and in the realities of resource constraints. Participants: Twenty-six participants representing general practice, medical academe, funding authorities, health policy planners, researchers, medicopolitical organisations and consumers. Results: The surveys yielded preferred strategies for implementation in the ideal world and 10 preferred strategies for implementation given likely resource constraints. Conclusions: Authoritative guidelines are needed to guide clinical practice and to evaluate research. Other comprehensive strategies to overcome barriers to preventive care must be implemented and evaluated for effectiveness and acceptability in field experiments before wider implementation. The controlled implementation and evaluation of these strategies requires genuine collaboration amongst clinicians, health policy planners, researchers, funding authorities and general practice academe.

Primary prevention aims to circumvent the onset of malignant change. Secondary prevention aims to detect early cancer or lesions with high malignant potential before extensive loc... [more]

Primary prevention aims to circumvent the onset of malignant change. Secondary prevention aims to detect early cancer or lesions with high malignant potential before extensive local growth or metastatic spread compromises the effectiveness of treatment. This article should help general practitioners appraise the value of cancer prevention measures and plan an effective approach to cancer prevention in clinical practice.

A stratified random sample of 655 Australian general practitioners (GPs) was surveyed to determine their attitudes, knowledge and behaviour in relation to the human immunodeficien... [more]

A stratified random sample of 655 Australian general practitioners (GPs) was surveyed to determine their attitudes, knowledge and behaviour in relation to the human immunodeficiency virus (HIV) pandemic. Of the 486 respondents, 22% had one or more patients with HIV infection in their practice and 80% had been asked for information on HIV infection in the past month by at least one patient. The majority of respondents viewed screening and education of patients as part of their role, but 24% did not want to maintain a therapeutic relationship with HIV-infected patients and 16% felt it was appropriate to refuse to treat this group. Although most respondents correctly identified the well known risk-taking behaviours for HIV infection in homosexual men and intravenous drug users, they underestimated the risk to heterosexuals and exaggerated that associated with activities generally considered not to involve risk. The knowledge of appropriate infection control procedures of approximately 60% of the respondents was inadequate. A lack of time in consulting was the most commonly cited barrier to the routine assessment of, or enquiry into, risk-taking behaviours of patients in the respondents' practices. Respondents noted that they required more knowledge of the clinical presentation and diagnosis of HIV infection, as well as education in counselling techniques and the risks of transmission associated with sexual and non-sexual activities. They felt such information could best be imparted through printed material. These results indicate that most GPs are willing to play an active role in the diagnosis, treatment and prevention of HIV disease, but they require more accurate information in order to fulfil this role appropriately. The study identifies and addresses several barriers to GPs playing a more active role in the management of HIV disease.

Because of the potential benefits of primary prevention and early detection of cancer, a considerable proportion of the efforts of State cancer organizations has been directed tow... [more]

Because of the potential benefits of primary prevention and early detection of cancer, a considerable proportion of the efforts of State cancer organizations has been directed towards public educational programs. The study aimed to determine the level of agreement in the messages contained in the written educational material of the State and Territory cancer organizations in Australia. Pamphlets and brochures dealing with primary and secondary prevention of breast, cervical, skin and bowel cancers were obtained. The materials were compared on a number of dimensions: the characteristics of people who are at increased risk of contracting the cancer, how to avoid the cancer through primary prevention, how and when to screen in the case of secondary prevention, and action to be taken if a sign or symptom indicative of cancer is discovered. The study found a lack of agreement in the messages of the State cancer organizations. Some hypotheses are suggested to explain the discrepancies. In addition, some suggestions for remedying this situation are provided.

The mass media are increasingly popular as a strategy for delivering preventive health messages. A review of the literature located 24 published evaluations of the effectiveness o... [more]

The mass media are increasingly popular as a strategy for delivering preventive health messages. A review of the literature located 24 published evaluations of the effectiveness of mass media programmes in modifying cardiovascular risk behaviour or safety restraint use among adults. Many of these studies failed to meet basic methodological criteria and were excluded from the review. The remaining studies were found to provide little support for the implementation of mass-media programmes to modify health risk behaviours. When media-alone interventions designed to alter behaviour directly have been evaluated, they have been found to have little impact on behaviour. When the media have been used in an agenda-setting role in combination with a community component, significant changes in behaviour have been reported. However, there is currently no evidence that the media component makes a contribution to the effectiveness of such combined programmes. Future research needs are discussed.

An observational study examined the care that was provided by 61 interns for three simulated (standardized) patients in a casualty department within a large teaching hospital. The... [more]

An observational study examined the care that was provided by 61 interns for three simulated (standardized) patients in a casualty department within a large teaching hospital. The consultations were recorded on videotape and were scored by reference to explicit criteria that were set by an expert panel. The criteria described standards of clinical competence, communication skills and preventive care for each of the three cases. An additional list of the general opportunities for preventive advice that were suggested by the patients' case histories was also compared with the interns' actual behaviour. Clinical competence was not demonstrated uniformly across the three cases. The problem of urinary-tract infection was managed best; 19% of the interns complied with all criteria, and 93% of the interns complied with 75% of the criteria. For tension headache, only 3% of the interns complied with all the criteria but 67% of interns complied with 75% of the criteria. In the case of bronchitis, only 3% of interns complied with all the criteria but 58% of interns met 75% of the criteria. The quality of preventive care also varied from case to case, being best for the patient with bronchitis and worst for the patient with tension headache. Over all, only three of the 13 criteria were met by more than half the interns. The communication-skills criteria identified three behaviours which the interns were most likely to omit: the interns summarized the patients' problems in only 73 of the 173 consultations; they explained the aetiology of the problems in only 127 of the 173 consultations; and they ensured that the patients understood their plan of management in only 21 of the 173 consultations.

SANSONFISHER RW, REDMAN S, OAK S, WEBB G, 'THE BURDEN OF ILLNESS THAT IS IMPOSED BY DRUG-ABUSE AND THE ALLOCATION OF RESEARCH MONIES IN THE FIELD - 3 VIEWS', MEDICAL JOURNAL OF AUSTRALIA, 149 134-138 (1988)

This study examined whether the interns who staffed a hospital casualty department identified correctly four common health risks among their patients. When compared with patients ... [more]

This study examined whether the interns who staffed a hospital casualty department identified correctly four common health risks among their patients. When compared with patients who were attending general practitioners, patients who attended the casualty department were more likely to be cigarette smokers. They were also more likely to be heavy drinkers of alcohol and to score highly on a standardized measure of psychological disturbance. Women were less likely to have undergone a Papanicolaou smear-examination within the previous two years. The interns, who were the subjects in this study, failed to identify 56% of the smokers, 84% of the heavy drinkers, 35% of the psychologically-disturbed patients and 95% of the women who had not undergone a Papanicolaou smear-test in the last two years. The findings were in contrast with the interns' own opinions on what would constitute good-quality care in this setting. The subjects were just beginning their internship at the time of the study. Their failure to integrate important questions about common health risks suggests that their undergraduate training has been deficient in this area. The internship is the last formal opportunity to correct this deficiency before these doctors are registered for independent medical practice.

Eight hundred and thirty-eight women who attended 36 general practitioners were asked when they had last undergone a cervical smear-test. Only 6% of women who were between 25 and ... [more]

Eight hundred and thirty-eight women who attended 36 general practitioners were asked when they had last undergone a cervical smear-test. Only 6% of women who were between 25 and 54 years of age had never undergone a smear-test, but in women who were younger and older than this age range the proportion was one-third. We estimated from this pattern of use of cervical smear-tests that only 60% of invasive cervical cancer is being prevented, and the major contribution to the remaining risk factors comes from women of over 55 years of age who either have not undergone a smear-test or had undergone one a long time previously. This information suggests that general practitioneres and the public-health system should be more active in ensuring that all at-risk women undergo cervical smear-tests.

Response bias in quality of care research is an important, but largely neglected concern. Differences between health care professionals who consent to participate in research and ... [more]

Response bias in quality of care research is an important, but largely neglected concern. Differences between health care professionals who consent to participate in research and those who do not may distort the conclusions and prevent the results being generalizable. This is particularly likely when response rates are low, as they often are in studies evaluating primary health care. The present study outlines a method for examining this important area. Fifty-six general practitioners who consented to participate in an observational study of general practice were compared with 52 doctors who declined to participate in the research. Comparisons were made of general characteristics including age, sex, practice size and postgraduate qualifications, as well as attitudes toward their role. This last analysis was deemed particularly important, as the attitudes expressed may have affected the behaviour of the doctor in the consultation, and therefore outcomes such as accurate diagnosis, compliance and satisfaction. Such outcomes are often the object of study in quality of care research. The only significant difference to emerge in the present study was that non-consenters were more strongly in favour of a medical system based on free enterprise and free for service (t83 = 2.3 P < 0.05). No systematic differences were found on other general characteristics or attitudes relating to patient care. Response bias using the stated variables was therefore considered to be minimal. The results are discussed in terms of strategies aimed at increasing response rates in quality of care research.

Fifty-four interns agreed to a study in which their clinical performance in an outpatient unit with standardized patients was recorded on videotape. In order to examine whether th... [more]

Fifty-four interns agreed to a study in which their clinical performance in an outpatient unit with standardized patients was recorded on videotape. In order to examine whether they could distinguish standardized from real patients, the interns were asked to note any patients who they thought might be simulating their complaints and report these to the researchers at the end of each 2-day period of study. Thirty-two of the interns were assessed again at the end of their internship, using the same clinical problems presented by different simulators. The consultations took place in the casualty department of a large urban hospital. At the beginning of the year there were 152 consultations with standardized patients and 328 consultations with appropriate genuine patients. Standardized patients were identified definitely as 'not genuine' in only 12 of the 152 consultations (sensitivity 7.8%) whereas 320 of the 328 genuine consultations were accepted by the interns as genuine (specificity 97.8%). When the level of confidence required to distinguish the two groups was reduced from 'definite' to 'probable', the number of correctly identified simulator consultations increased to 36/152 (27%) but the rate of misclassification of genuine patients also increased from 8 to 37 out of 328 consultations (11%). At the end of the year there were 81 consultations with standardized patients and 149 consultations with genuine patients. Identification rates were only slightly changed. We conclude that simulator identification is not a problem in applying standardized patients to evaluate the quality of care provided in a hospital casualty.

We devised a reliable coding system in order to analyse interactional events between general practitioners and patients that were observed on the videotapes of 201 consultations i... [more]

We devised a reliable coding system in order to analyse interactional events between general practitioners and patients that were observed on the videotapes of 201 consultations in which an antibiotic agent was prescribed. Of total consultation events, doctors contributed 14% on the collection of information about the presenting condition for which antibiotic agents were prescribed; 22% on the giving of such information; 17% on social exchanges; and 21% of events were devoted to other problems that emerged during the consultation. Patient questions made up 2% of events and were encouraged specifically by 1% of events. Whereas 75% of patients were told the dose and length of the course, only 46% of patients were told the name of the antibiotic agent, only 10% of patients were told of side-effects, and no patient was told what to do if he or she forgot a dose. Not surprisingly, with the exception of the justification of the treatment that was chosen, practitioners seldom used techniques which have been shown to be effective in the improvement of patient compliance or recall of information. Given that antibiotic agents are prescribed commonly, and compliance is frequently poor, our findings have implications for undergraduate, vocational and continuing education.

The construction and development of a questionnaire which measures the attitudes of general practitioners towards their role in the medical care system is described. Factor analyt... [more]

The construction and development of a questionnaire which measures the attitudes of general practitioners towards their role in the medical care system is described. Factor analytic procedures identified seven reliable factor-based subscales. The subscales measured attitudes towards: a psychological orientation to patient care, government involvement in the health care system, preventive medicine, patient participation in the consultation, communication with patients, responsibility for decision making and the appropriateness of consulations. The responses of 387 randomly selected Australian general practitioners to this measure are described. Overall, there was strong support for the importance of fostering patient participation, facilitating open communication and understanding, having a psychological orientation, and implementing preventive activities in general practice. However, the sample was strongly opposed to a government regulated health care system. Age and sex of the general practitioner were shown to influence orientations on some dimensions.

Dissatisfaction with the traditional methods of selecting Australian medical students, which use only secondary school achievement, led to an innovative alternative method at the ... [more]

Dissatisfaction with the traditional methods of selecting Australian medical students, which use only secondary school achievement, led to an innovative alternative method at the Newcastle Medical School. This multistage approach uses tests of problem-solving ability, empathy, creativity and moral dilemmas to screen applicants otherwise suitable on academic achievement. In the 5-year trial since its inception, this process appears reasonably reliable and valid. There is some merit in using a composite score for ranking applicants, bases on weighted contributions from the psychological tests used in its multifactorial battery. However, the ultimate effectiveness of individual tests of a composite score will depend on their predictive validity, which is yet unmeasured.

A review of studies which used standardized interviews as a means of data collection indicated that the issue of reliability was frequently neglected in the psychiatric literature... [more]

A review of studies which used standardized interviews as a means of data collection indicated that the issue of reliability was frequently neglected in the psychiatric literature. It is suggested that this may be due to a misinterpreteation of the concept of reliability which is apparently perceived as a permanent feature of an interview instrument. The importance of reliability is discussed, and recommendations are made as to how a methodologically adequate assessment of reliability might be undertaken.

Paul CL, Bonevski B, Bryant JL, Sanson-Fisher RW, 'Approaches to tobacco control and population effects: how good is the evidence that standard approaches are equitable', 12th Annual Meeting of the SRNT Europe Programme, Bath, UK (2010) [E3]

Sanson-Fisher RW, 'Accelerating the development of evidence for drug and alcohol practice and policy', The Australasian Professional Society on Alcohol and Other Drugs (APSAD) Conference: Abstracts, Sydney, NSW (2008) [E3]

Internationally renowned cancer control
and health behaviour researcher, Laureate Professor Robert Sanson-Fisher AO,
has taken out the inaugural Research Australia NSW Government Health Services
Research Award.

Internationally-renowned
cancer care and health behaviour researcher, Laureate Professor Robert
Sanson-Fisher AO, has won the inaugural Research Australia NSW Government
Health Services Research Award.

In a
region where 70 per cent of adults are overweight or obese, a new study
conducted by University of Newcastle and HMRI researchers has found that
doctors are falling short in detecting weight conditions, which may lead to
inadequate assistance with managing weight.

Opinion on the state of Indigenous health research by Ms Amanda A. Jayakody, Laureate Professor Robert W. Sanson-Fisher and Dr Jamie Bryant from the Priority Research Centre for Health Behaviour School of Medicine and Public Health, Faculty of Health, University of Newcastle.

Laureate Professor Robert Sanson-Fisher

Position

Laureate ProfessorHealth Behaviour Research GroupSchool of Medicine and Public HealthFaculty of Health and Medicine